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Published on: September 7, 2022
Patients Undergoing Manipulation Under Anesthesia Recover Mobility, But Have Worse Functional Outcomes
Craig Israelite1, Robert Barrack2, Jared Foran3
1Orthopedic Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania.
Background:
To regain range of motion (ROM) after total knee arthroplasty, manipulation under anesthesia (MUA) may be recommended; however, restoration of gait following MUA requires clarification. The purpose of this study was to compare gait quality metrics, function, and ROM between stiff-kneed patients who underwent and did not undergo MUA.
Methods:
This study was a secondary data analysis of a large multicenter, observational cohort study in which patients used a digital care management platform with a smartwatch before and after total knee arthroplasty. Patients who had active flexion less than 90° at one month postoperatively were divided by occurrence of MUA (MUA: n = 52; non-MUA: n = 218). Patient recovery following MUA was evaluated via active flexion ROM, Knee Osteoarthritis and Outcomes Scale for Joint Replacement (KOOS JR), and objective gait metrics.
Results:
On average, gait metrics of participants who received an MUA decreased 1 to 8 percentiles compared to non-MUA patients immediately post-MUA, with significant differences between cohorts at five days post-MUA for walking speed (P = 0.02) and step count (P = 0.05), but not walking asymmetry (P = 0.09). All gait metrics were similar between cohorts at 10-days through 30-days post-MUA (P = 0.05). There were no significant (P = 0.09) differences in preoperative ROM between the MUA and non-MUA cohort, but ROM was reduced in the MUA cohort at one (75.0 versus 80°, P = 0.002) and three months (105 versus 115°, P = 0.048) postoperative. Similarly, KOOS JR did not differ significantly between cohorts preoperatively (P = 0.960), but was significantly (P = 0.0021) lower in the MUA cohort at three months, six months, and 12 months postoperative.
Conclusions:
Gait metrics normalized within five to 10 days after MUA, whereas KOOS JR scores remained lower in the MUA cohort for up to one year, highlighting a disconnect between objective and patient-reported outcomes. These findings underscore the importance of surgeon awareness when counseling patients about the expected recovery trajectory after MUA.